Cited by 43Suicide and Self-Harm StudiesSmoking Behavior and CessationSubstance Abuse Treatment and Outcomes

Cigarette smoking and completed suicide: Results from 3 prospective cohorts of American adults

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Lucas, Michel, O’Reilly, Eilis J., Mirzaei, Fariba, Okereke, Olivia I., Unger, Leslie, Miller, Matthew, Ascherio, Alberto·2013·Journal of Affective Disorders

Abstract

Background Prior reports have indicated a potential dose-response relationship between smoking and suicide. However, this relationship is controversial.Methods This study evaluated the association between smoking and risk of death from suicide in three large-scale cohorts of U.S. men and women (n=253,033). Suicides were identified from death certificates among 43,816 men enrolled in the Health Professionals Follow-up Study (HPFS) between 1986 and 2008, 116,566 women in the Nurses' Health Study (NHS) between 1976 and 2008, and 92,651 women in the NHS II between 1989 and 2007. Information on smoking was obtained at baseline and updated every 2 years. Relative risks (RRs) of suicide were estimated using Cox proportional hazards regression models. Cohort specific RRs were pooled using random-effects models. Suicide deaths were determined by physician review of death certificates.Results A total of 457 deaths from suicide were documented. Compared to never smokers, the pooled multivariate RR (95% confidence interval [CI]) of suicide was 1.15 (0.91-1.45) for former smokers and 2.69 (2.11-3.42) for current smokers. A nonmonotonic dose-response relationship was noted between the number of cigarettes smoked per day (CPD) and suicide risk (P trend<0.001). Compared to never smokers, the pooled multivariate RR (95% CI) was 2.59 (1.77-3.79) for those with 1-14 CPD, 2.03 (1.39-2.94) for those with 15-24 CPD, and 4.13 (2.96-5.78) for those with ≥ 25 CPD.Limitations Smoking was self-reported and had some degree of measurement error. Participants were not a representative sample of the U.S. population.Conclusions Results from three large cohorts suggest a nonmonotonic dose-response association between smoking and suicide risk.

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Crossref · 10.1016/j.jad.2013.08.033

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  • Active smokers have about two to three times the risk of suicidality compared with people who never smoked.

    “Although active smokers have been reported to have twofold to threefold increased risk of suicidality when compared to nonsmokers,1–4”

    From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [7]

    The Results report a pooled relative risk of 2.69 for completed suicide among current smokers compared with never smokers, supporting the stated twofold-to-threefold magnitude. The study measured suicide deaths, however, not suicidality more broadly, such as suicidal thoughts or attempts. (LLM, conf=0.84)

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Authors
Lucas, M., O’Reilly, E. J., Mirzaei, F., Okereke, O. I., Unger, L., Miller, M., & Ascherio, A.
Affiliations
  • Harvard University (US)
  • Brigham and Women's Hospital (US)
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2013-12
Volume
151
Issue
3
Pages
1053-1058
ISSN
0165-0327 (ISSN-L)
OpenAlex
W2063277089
Cited by
43
References
48
Citations by year
2025: 5 · 2024: 4 · 2023: 1 · 2022: 1 · 2021: 4 · 2020: 3 · 2019: 2 · 2018: 5 · 2017: 5 · 2016: 5 · 2015: 5 · 2014: 3
FWCI
4.82
Type
journal article
Language
en
Open access
Locations
  • Journal of Affective Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
Nurses’ Health Study and Health
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
cigarette smoking, suicide, suicide risk, dose-response relationship, current smokers, former smokers, cigarettes per day, non-monotonic dose-response, Health Professionals Follow-up Study, Nurses' Health Study, Nurses' Health Study II
MeSH terms
Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Smoking, Suicide, United States, Cohort Studies, Proportional Hazards Models

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